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APENDISITIS

Stase Ilmu Bedah RSIJ Cempaka Putih

Pembimbing: dr. Winoto, Sp.B

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PANJANGNYA

KIRA-KIRA

ADA

KESAMAAN

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Anatomi

Berasal dari MID GUT

Di fossa iliaka kanan titik

Mc. Burney

Basis di puncak sekum

pertemuan 3 taenia

Bentuk tabung, panjang 3

15 cm

Pangkal lumen sempit,

distal lebar Lokasi : retrosekal (65%),

pelvinal, antesekal, medial,

preileal,postileal, dll

Vaskularisasi A.a endikularis end arteri

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Definition

Appendicitis is a

condition characterized

by inflammation of the

appendix. It is

classified as a medical

emergency and many

cases require removal

of the inflamed

appendix, either bylaparotomy or

laparoscopy.

Untreated,

mortality is high,

mainly because of

the risk of rupture

leading to

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Etiology

Obstruksi

Lumen

HiperplasiaLymphoid

Fecalith

Foreign object

Neoplasma

Parasit

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Patogenesis

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APENDISITIS AKUTSymptoms :- Nyeri visera di epigastrium, sekitar umbilicus- Mungkin Kolik

Patogenesis

tekanan intraluminer tinggi

mukus >>>

gangguandrainase

limfe

edema +ulserasimukosa

Obstruksi

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Patogenesi

s

Appendisitis

APENDISITIS AKUT SUPURATIF / PURULENTASymptoms- Nyeri sentral berpindah ke perut kanan bawah- Nyeri somatik ( peritonitis lokal)

- Mual dan muntah

obstruksivena

Trombosis

Iskemiaedema

semakinberat

invasikuman

TekananIntralumen

Tinggi

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Gejala Klinis

Nyeri samar-samar dan

tumpul

Nyeri pada titikMcburney

Sakit bertambahMual dan

kadang adamuntah

Konstipasi/diare

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Pemeriksaan Fisik

KEADAAN UMUM

Demam ringan 37,5

0

38,50

C(beda 1

0

C rektaldan aksiler sudah

bermakna) Demam tinggi

infiltrat, abses,peritonitis

Nadi cepat infiltrat, abses,peritonitis

Kurang bergerak,paha difleksikan

INSPEKSI

Tidak tampakkelainan

Penonjolan perutkanan bawah

INFILTRAT ATAUABSES

Cembung ikutgerak nafas PERFORASI /PERITONITIS

PALPASI

Nyeri tekan perutkanan bawah (McBurney)

Massa di perut

kanan bawah INFILTRAT ATAUABSES

Defans lokal defans menyeluruh sudahPERITONITIS

BLUMBERG SIGN, ROVSING SIGN

OBTURATORSIGN, PSOASSIGN

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McBurneys Point

McBurneys point (1) appears

about one-third of the distance

along a line starting at the right

ASIS (3) and ending at theumbilicus 2 .

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Anatomic basis for the

psoas sign: inflamedappendix is in a

retroperitoneal location in

contact with the psoas

muscle, which is stretched

by this maneuver.

The psoas sign. Pain on

passive extension of the rightthigh. Patient lies on left side.

Examiner extends patient's

right thigh while applying

counter resistance to the right

hip (asterisk).

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Anatomic basis for the

obturator sign: inflamedappendix in the pelvis is in

contact with the obturator

internus muscle, which is

stretched by this maneuver.

The obturator sign. Pain on

passive internal rotation of theflexed thigh. Examiner moves

lower leg laterally while

applying resistance to the

lateral side of the knee

(asterisk) resulting in internalrotation of the femur.

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Pemeriksaan Fisik

PERKUSI

Nyeri ketokperut kananbawah

Pekak heparhilang PERFORASI

(sering pekakada)

AUSKULTASI

Peristaltiknormal

Bising ususmenghilang PERITONITIS

COLOKDUBUR

Nyeri pukul 10 11 LETAKPELVINAL

Sfingterlonggar bilaPERITONITIS

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Pemeriksaan Penunjang

Laboratorium:

Peningkatanjumlah leukosit

CRP, Urinalisa

Foto polosabdomen

Ultrasonografi

CT-scan Laparoskopi Histopatologi

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In fewer than 5 percent of

patients, an opaque fecalith

may be apparent in the right

lower quadrant. Plainabdominal films generally are

not recommended unless

other conditions(e.g.,

perforation, intestinal

obstruction, ureteral calculus)are suspected.8 Likewise, as

advanced cross-sectional

imaging techniques have

become available, barium

enema is now used

infrequently.

COMPUTED TOMOGRAPHY

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Ultrasonogram

showing longitudinal

section (arrows) of

inflamed appendix.

ULTRASONOGRAPHY

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Computed

tomographicscan showing

enlarged and

inflamed

appendix (A)

extending fromthe cecum (C).

Computed

tomographic scan

showing cross-

section of

inflamed

appendix (A) with

appendicolith (a).

COMPUTED TOMOGRAPHY

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Alvarado Scale for the Diagnosis of Appendicitis

Manifestations

Value

Symptoms Migration of pain 1

Anorexia 1

Nausea and/or vomiting 1

Signs Right lower quadrant tenderness (Nyerifossa iliaca kanan)

2

Rebound (Nyeri lepas) 1

Elevated temperature (> 37,30C ) 1

Laboratory values Leukocytosis (> 10103/L ) 2

Left shift in leukocyte count

(neutrofil > 75% )

1

Total points 10

>7 : Appendiksitis akut

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Skor 1 4 : dipertimbangkan appendicitis

akut : Observasi

Skor 5

6 : possible appendicitis tidak

perlu operasi : Antibiotik

Skor 7 9 : appendicitis akut perlu

pembedahan : Operasi dini

Modified Alvarado score (Kalan et al) tanpa observasi of

Hematogram

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DIANGNOSIS BANDING

Gastroenteritis Demam Dengue

Limfadenitis Mesenterika

Kelainan Ovulasi Infeksi Panggul

Kehamilan di Luar Kandungan

Kista Ovarium Terpuntir

Endometriosis Eksterna Urolitiasis Pielum/Ureter Kanan

Penyakit Saluran Cerna Lainnya

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Penatalaksanaan

Apendectomy Drainage Conservative

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Appendectomy

An appendectomy (sometimescalled appendisectomy or

appendicectomy (British English))is the surgical removal of the

vermiform appendix

An appendectomy may belaparoscopic or traditional.

Laparoscopic surgery uses a fewsmall incisions.

The various layers of the abdominalwall are then opened,

On entering the peritoneum, theappendix is identified, mobilized andthen ligated and divided at its base

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Drainage involves placing aneedle through the skin in

the abscess, usually under x-ray guidance. The drain is

then left in place for days or

weeks until the abscess goesaway.

PAD is performed usingstandard aseptic technique

and local lidocaineanesthesia. Begin with adiagnostic aspiration,followed by catheter

placement if fluid is purulent

Drainage

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Pada InfiltratAppendikularis

Prosedur Oshner-Shener

1. Istirahat total

2. Posisi fowler

3. Antibiotika

4. Monitoring suhu ,ukuran tumor,

Laju endap darah (led) &leukosit

Appendectomy elektifsetelah 12 minggu

Conservative

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Posisi duduk atau setengah duduk, bagian kepala tempat

tidur lebih tinggi atau dinaikkan.

Fowler (45o-90o) dan semi fowler (15o-45o).

Dilakukan untuk mempertahankan kenyamanan,memfasilitasi fungsi pernapasan, dan pasien pasca bedah.

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REFERENSI

1. De Jong, W. & Sjamsuhidajat, R.,2004. Buku Ajar Ilmu Bedah Edisi 2. EGC.Jakarta.

2. Reksoprodjo, S., dkk. 1995. Kumpulan Kuliah Ilmu Bedah. Bagian Bedah Staf

Pengajar Fakultas Kedokteran Universitas Indonesia. Bina Rupa Aksara. Jakarta.

3. Mansjoer, A., dkk. 2000. Kapita Selekta Kedokteran Edisi Ketiga Jilid Kedua.

Penerbit Media Aesculapius Fakultas Kedokteran Universitas Indonesia. Jakarta.

4. Bagian Ilmu bedah Fakultas Kedokteran Universitas Sumatra Utara.

http://library.usu.ac.id/ download/fk/bedah-emir%20jehan.pdf

5. Mubin, Halim. Buku Panduan Praktis : Ilmu Penyakit Dalam Diagnosis dan

Terapi Edisi 2. Jakarta : Penerbit Buku Kedokteran EGC. 2007.

6. Price, Sylvia A. Patofisiologi : Konsep Klinis Proses-Proses Penyakit, Edisi 4.

Jakarta: Penerbit Buku Kedokteran EGC. 1995.

7. Schwartz, Spencer, S., Fisher, D.G., 1999. Principles of Surgery Sevent Edition.

Mc-Graw Hill a Division of The McGraw-Hill Companies. Enigma an Enigma

Electronic Publication.

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. . .TERIMAKASIH. . .